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Atul Gawande―general surgeon at Boston's Brigham and Women's Hospital and a Harvard Medical School professor―concludes that while medicine is important, it is not the only framework to use when considering disease and end-of-life options. Asking people what they want, for example, helps determine an individual's priorities which informs medical and other decisions.

Gawande does a terrific job of explaining the changes which have resulted in more older adults living in nursing homes. He explains, for example, that extended families are not the norm and have not been for many years. In order for young people to succeed, they move away, often to cities, for education and work. This leaves parents and other relatives alone to care for themselves. Doctors, and nurses, are often called in to help make decisions that families had once made for and with older relatives. (Gawande's explanation is better; go to minute 4:05.)